Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Ama - Anxiety, ADHD, Bipolar > Bipolar - Lithium > Flashcards

Bipolar - Lithium Flashcards

1
Q

Lithium

A

Used for the prophylaxis and treatment of mania, hypomania, depression in bipolar disorders, resistant depression and aggressive or self-harming behaviour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Therapeutic range

A

0.4 mmol/L - 1 mmol/L (lower end for prophylactic treatment/elderly)

0.8 mmol/L - 1 mmol/L for acute manic episodes, patients who have previously relapsed or have subsyndromal symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Plasma lithium monitoring

A

Blood samples taken 12 hours after dose.
Weekly, then every 3 months once dose stable for the first year, then every 6 months thereafter.
Additional monitoring if:
- Significant intercurrent illness
- Significant changes to diet or water intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lithium - monitoring (other)

A

EVERY 6 MONTHS
- Renal function
- Cardiac function
- Thyroid function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Withdrawal

A

Avoid abrupt withdrawal
Higher risk of relapse otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Toxicity

A

REVeNGe

Renal disturbances
Extrapyramidal symptoms
Visual disturbances (blurred vision)
Nervous system disturbances
GI effects (diarrhoea/vomiting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Renal disturbances

A

Polyuria
Incontinence
Hypernatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Extrapyramidal symptoms

A

Fine treatment increasing to course tremor
Ataxia
Dysarthria
Myoclonus
Nystagmus
Muscle weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Nervous system disturbances

A

Confusion and drowsiness, increasing to incoordination, restlessnes and stupor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Other symptoms of lithium toxicity

A

Signs and symptoms of hypothyroidism
- Unexplained fatigue
- Weight gain
- Hair loss

Signs and symptoms of benign intracranial hypertension
- Persistent headache
- Visual disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What levels is lithium toxic at?

A

2 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Effects of toxicity

A

Seizures
Coma
Renal failure
Arrhythmias
BP changes
Circulatory failure
Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lithium - Side effects associated with long-term use

A

Mild cognitive/memory impairment
Thyroid disorders
- Monitoring = thyroid function tests
- Hypothyroidism = weight gain/fatigure
- May also cause hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lithium - other side effects

A

Renal impairment
- Lithium is nephrotoxic and renally cleared
- Monitoring = renal function tests
- Reporting = polyuria, polydipsia

Benign intracranial hypertension
- Reporting = persistent headaches, visual disturbances

QT prolongation
- Monitoring = cardiac function

Lowers seizure threshold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Lithium - Prescribing

A

Prescribe by brand.
Lithium salts and different preparations vary in bioavailability.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lithium + hyponatraemia

A

Patients with hyponatraemia who take lithium are predisposed to lithium toxicity

17
Q

Pregnancy + BF

A

Teratogenic
Effective contraception in women of child-bearing age.
Toxicity can occur in breastfed infants

18
Q

Counselling points

A
  • Report signs and symptoms of lithium toxicity
  • Maintain constant, adequate salt + water intake. ESP if infection, diarrhoea or vomiting (can cause dehydration)
  • Can cause drowsiness. Avoid alcohol. Don’t drive/operate skilled machinery if drowsy.
  • Lithium treatment pack = PIL, alert card, record book. Always carry with you
19
Q

Interactions - increases risk of seizures

A

Quinolones (ciprofloxacin)
SSRIs
Epilepsy (lowers seizure threshold)

20
Q

Interactions - lithium toxicity

A

Reduced renal excretion = increased risk of toxicity
- ACEi/ARBs
- NSAIDs

Causes hyponatraemia which predisposes to lithium toxicity
- Diuretics
- Antidepressents

21
Q

Interactions - increased risk of extrapyramidal symptoms

A

Antipsychotic drugs
- Haloperidol
- Clozapine
- Metoclopramide
Parkinson’s disease
Metoclopramide

22
Q

Interactions - increased risk of neurotoxicity

A

Phenytoin
Carbamazepine
Antipsychotics
Amitriptyline

23
Q

Interactions - Increased risk of serotonin syndrome

A

Sumatriptan (5-HT1a agonist)
Citalopram (SSRIs)
Granisetron
MAOIs
Amfetamines
St. Johns Wort
Tramadol

24
Q

Interactions - QT interval prolongation = increased risk of arrhythmias

A

Drugs that prolong QT:
- Quinolones
- Citalopram
- Clarithromycin
- Amiodarone
- Antipsychotics
- Imipramine

Drugs that cause hypokalaemia (can lead to QT interval prolongation):
- Theophylline
- Corticosteroids
- B2 agonists
- Loop/thiazide diuretics

25
Q

Interactions - OTC

A

Soluble/effervescent analgesics (high salt)
Sodium containing antacids

Ama - Anxiety, ADHD, Bipolar (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions